SPAP Chartbook Updated - The Commonwealth Fund

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Transcript SPAP Chartbook Updated - The Commonwealth Fund

Rizzo, Fox, Trail, and Crystal, State Pharmacy Assistance Programs: A Chartbook—Updated and Revised, January 2007
SPAP Other Eligibility Requirements
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In addition to income requirements, some SPAPs had eligibility requirements for assets, length of state residency,
existing prescription drug coverage, and other requirements.
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The MMA requires an asset test for its low-income subsidy. For applicants under 135% of FPL, the asset limits are
$6,000 (single)/$9,000 (couple) and for applicants under 150% of FPL, the asset limits are $10,000/$20,000.
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In contrast, Maryland and Minnesota were the only two SPAP states that had asset tests. In 2003, these were
$3,750/$4,500 in Maryland, and $10,000/$18,000 in Minnesota.
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Most states allowed current residents to enroll in their programs, but some required applicants to have been state
residents for up to one year.
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Most states excluded persons with any other drug coverage from eligibility. However, some states allowed persons
to receive SPAP benefits after their other benefits had been exhausted (4 states) or if their other coverage is less
generous than that available through the SPAP (3 states). Pennsylvania, Illinois, and Wisconsin had no such
restrictions on other coverage, but beneficiaries in Illinois and Wisconsin were required to assign their other benefits
to the state.
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While all SPAPs excluded persons from eligibility if they already received Medicaid prescription drug coverage, a
few states (Delaware, Massachusetts, Nevada, and Wyoming) excluded persons if they were eligible for Medicaid,
even if not actually enrolled in Medicaid.
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Effective January 2006, Medicaid drug coverage was replaced by the Medicare Part D benefit. Dual-eligibles
were auto-enrolled into a Medicare prescription drug plan, if they had not selected a prescription drug plan by
November 15, 2005, but were given the option of opting out.
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